Dr. Jeremiah Tao, left, and Dr. Lilangi Ediriwickrema work closely with a team of specialists to treat thyroid eye disease.
Photo by Carlos Puma
Thyroid eye disease is an autoimmune disorder that can wreak havoc on a patient's vision and appearance, causing dryness, redness, double vision, difficulty closing eyelids and in some cases, a noticeable bulging of the eyes.
“Moderate to severe thyroid eye disease can also be socially stigmatizing, affecting patients beyond their clinical symptoms,” says Dr. Lilangi S. Ediriwickrema, a UCI Health ophthalmologist at the Gavin Herbert Eye Institute and an assistant professor in the UC Irvine School of Medicine’s Department of Ophthalmology.
Ediriwickrema, who specializes in oculofacial plastic surgery and neuro-ophthalmology, is part of an interdisciplinary team formed to treat patients with thyroid eye disease.
First to diagnose
While the disease most often affects individuals who are already experiencing an overactive thyroid, it sometimes appears in individuals with low or even normal thyroid levels — especially if they smoke. It’s not unusual for an ophthalmologist to be the first to diagnose a thyroid imbalance when a patient seeks care for dryness, vision problems and eyelid swelling.
At the eye institute, patients diagnosed with thyroid eye disease may be referred to the oculofacial plastic and orbital surgery team led by Dr. Jeremiah P. Tao. He and Ediriwickrema work closely with various specialists to determine the best treatment options, with the ultimate goal of preserving vision.
For some patients with thyroid eye disease, prescription medicine may offer relief and allow the condition to resolve itself. In certain cases, however, surgery is the most effective and efficient treatment.
“It’s important for patients to be seen by specialists who have all the tools in their toolbox to not only monitor their condition but also treat the disease,” explains Tao, a professor of ophthalmology at the medical school.
Surgical interventions
Patients with moderate to severe thyroid eye disease may undergo what is known as decompression surgery.
In this procedure, the goal is to create more space around the eye to accommodate the swelling that leads to bulging of the eye and, in some cases, vision loss. Typically, this involves removing some bone around the eye.
“Inflammation in the eye socket can cause an assortment of problems,” explains Tao. “Decompression surgery sometimes offers immediate relief and takes pressure off the optic nerve, thereby reducing the risk of permanent vision loss.”
Patients whose thyroid eye disease causes double vision may require strabismus surgery to adjust eye muscles to allow the eyes to move together again.
People with complications such as severe dry eye may need a cornea specialist to help manage their care.
Oculoplastic surgery by Tao or Ediriwickrema may be recommended for patients with eyelid retraction problems or to remove extra tissue and fat accumulation around the eye as a result of the disease.
Evolving therapies
Both eye surgeons are optimistic that new therapeutic options will emerge to provide customized, multidisciplinary care for thyroid eye disease.
With funding from the National Institutes of Health, Ediriwickrema is studying how the inflammatory condition affects blood vessels and other tissue around the eye.
“The treatment landscape is continually evolving,” she says. “We hope that in the next 10 to 20 years we can offer patients even more options to manage this disease.”
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